目的 探讨血清白细胞介素 33(IL-33)、可溶性生长刺激表达基因 2 蛋白(sST2)、同型半胱氨酸(Hcy)在老年急性脑梗死(ACI)患者中的表达,及其与短期预后的关系.方法 选择 2020 年 9 月至 2022 年 7 月在邯郸市中心医院住院治疗的老年 ACI患者 80 例为病例组和体检健康者 85 例为对照组.老年 ACI患者治疗 90d后评估改良 Rankin量表(mRS)评分,其中 mRS评分≤2 分的患者作为预后良好组 51 例,mRS评分>2 分的患者作为预后不良组 29 例.检测所有受试者血清 IL-33、sST2、Hcy水平;分析老年 ACI 患者短期预后不良的影响因素及血清IL-33、sST2、Hcy水平对老年 ACI患者短期预后不良的预测价值.结果 病例组血清 IL-33、sST2、Hcy水平明显高于对照组(P<0.01).预后不良组患者血清 IL-33、sST2、Hcy 水平明显高于预后良好组(P<0.01).logistic 回归分析显示,血清 IL-33、sST2、Hcy水平均是影响老年 ACI 患者短期预后不良的独立危险因素(P<0.01).血清IL-33、sST2、Hcy、三者联合检测预测老年 ACI患者短期预后不良的 ROC 曲线下面积(AUC)分别为 0.788(95%CI:0.669～0.907)、0.826(95%CI:0.729～0.924)、0.803(95%CI:0.698～0.907)、0.955(95%CI:0.898～1.000);三者联合检测的 AUC明显高于血清 IL-33、sST2、Hcy各自单独的 AUC(P<0.05).结论 老年 ACI 患者血清 IL-33、sST2、Hcy水平呈高表达,联合检测三者水平更有利于预测老年 ACI患者短期预后.

目的 探讨Forns指数、基于4因子的纤维化指数(FIB-4)、天冬氨酸转氨酶/血小板比值(APRI)、谷氨酰转移酶/血小板比值(GPR)对慢性乙型肝炎病毒(HBV)感染合并非酒精性脂肪肝病(NAFLD)患者肝纤维化的诊断效能.方法 选取2017年10月—2019年5月我院收治的HBV感染合并NAFLD 106例,依肝穿刺活检结果分为非显著性纤维化76例(非显著组)与显著性纤维化组30例(显著组),并于入院次日行无创血清学筛查,按公式计算Forns指数、FIB-4、APRI与GPR,绘制受试者工作特征曲线分析4种无创模型对HBV感染NAFLD患者显著性肝纤维化的诊断效能,采用Spearman等级相关分析探讨4种无创模型与患者肝纤维化分级的关系.结果 显著组HBV DNA、丙氨酸转氨酶、天冬氨酸转氨酶、γ-谷氨酰转移酶均高于非显著组,血小板计数、白细胞计数低于非显著组,差异有统计学意义(P<0.01).显著组Forns指数、FIB-4、APRI、GPR均高于非显著组(P<0.05,P<0.01).Forns指数、FIB-4、APRI、GPR中以GPR预测HBV感染合并NAFLD患者显著性肝纤维化的效能最高,其次为APRI,但4项联合诊断效能优于单独诊断.Spearman等级相关分析结果显示,HBV感染合并NAFLD患者Forns指数、FIB-4、APRI、GPR与肝纤维化分级均呈正相关(r=0.855、0.813、0.725、0.891,P<0.01).结论 Forns指数、FIB-4、APRI、GPR对HBV感染合并NAFLD患者显著性肝纤维化均有较高的预测效能,且联合诊断效能优于单独诊断;以上4种无创模型均与患者肝纤维化分级存在明显相关性.

目的 讨论在老年胸腰椎压缩性骨折患者围手术期中应用快速康复外科理念进行干预的临床应用价值.方法 随机抽取2018年5月至2019年5月收治的老年胸腰椎压缩性骨折患者60例作为研究对象,用随机数字表法将所有患者分为两组,其中参照组(n=30例)患者使用常规护理方案,观察组(n=30例)患者基于参照组增加运用快速康复外科理念.结果 相较于参照组,观察组的在院诊治时长、初次下床时间均明显缩短(P<0.05);观察组的护理服务满意度明显提升10.00％(P<0.05).结论 在老年胸腰椎压缩性骨折患者围手术期中应用快速康复外科理念进行干预,有助于改善患者预后,加快患者骨折部位的愈合进程,且有助于创建良好、和谐的护患关系.

目的:探讨医护一体化分层级责任制护理对骨科患者自我效能及依从性的影响。方法:选取该院骨科2017年1～12月收治的患者60例，随机分为对照组和研究组各30例。对照组行骨科常规护理，研究组行医护一体化分层级责任制护理。比较两组干预前后自我效能及依从性情况。结果:干预前，两组自我效能和依从性无明显差异( P>0.05)；干预后3个月，研究组自我效能和依从性评价均明显高于对照组( P<0.05)。 结论:骨科患者应用医护一体化分层级责任制护理模式干预，能有效提升自我效能和依从性，保证治疗效果。

Objective:To investigate the effects of ursolic acid (UA)on xenografts growth in osteosarcoma of nude mice. Methods:Nude mice models bearing human osteosarcoma were made by injecting inoculation human osteosarco-ma cancer MG - 63 cell line and were treated with different concentrations of UA [5,10,20mg/(kg·d)]and cispl-atin (2mg/ kg)for 5 days,once a day. The histopathological changes of tumor tissue was observed by HE staining. The tumor cells apoptosis was detected by TUNEL. The expression of caspase - 3,Bax,bcl - 2 protein were detected by IHC and were semi - quantitative analyzed. Results:Compared with model group,the necrosis presentation,tumor cell shrinkage and other pathological morphological changes appeared. The number of apoptotic cells in tumor tissue of UA treated groups were significantly increased. The tumor weight were decreased and the inhibition rate were increased. The expression of Bax and caspase - 3 were significantly increased and the bcl - 2 protein was significantly de-creased,and the ratio of Bax/ bcl - 2 were significantly increased. All of the effects of UA above were dose - depend-ent with a certain. Conclusion:UA had inhibitive effects on xenografts growth in osteosarcoma cancer of nude mice perhaps through depressing apoptosis,which perhaps related to its effects of regulating the expression of apoptosis - re-lated proteins (caspase - 3,Bax,bcl - 2)and increasing the ratio of Bax/ bcl - 2.

Objective To investigate the effects and mechanism of ursolic acid( UA) on immune function of osteosarcoma cancer rats. Methods The osteosarcoma cancer rat models were conducted by injecting osteosarcoma cancer cell line UMR106 and were treated with UA 100,50,25 mg/(kg·d) and Cisplatin 2. 5 mg/(kg·d) by intraperitoneal injection for 5 d. The rats' general states and tumor growth conditions were observed,the histopathological changes of tumor tissue were observed by HE staining; he tumor weight was detected and inhibition rate was calculated, the spleen lymphocyte transformation rate was detected by MTT, the content of IL-2 and TNF-αin serum were detected, the percentage of CD4+, CD8+in blood were detected and the ratio of CD4+/CD8+ was calculated. Results The diet situation of the rats in UA treated groups were improved, tumor were reduced and hardness were less, tumor cell showed shrinkage, tissue necrosis, etc; the tumor inhibition rate were increased; the spleen lymphocyte transformation rate were significantly increased;the content of IL-2 and TNF-αin serum were significantly decreased;the CD4+percentage in blood were significantly increased, the CD8+percentage was significantly decreased, the ratio of CD4+/CD8+ in UA treated groups were significantly increased. The effect of the above mentioned effects of UA has a certain dose dependence. Conclusion UA can effectively improve the immune function of osteosarcoma cancer rat;which perhaps related to its effects of increasing the spleen lymphocyte transformation rate, reducing the content of IL-2 and TNF-α, increasing CD4+ percentages,de-creasing CD8+ percentages and raising the ratio of CD4+/CD8+.

Objective To investigate the effects of Ursolic Acid(UA) on the proliferation and apoptosis of human osteosarcoma MG-63 cells.Methods The human osteosarcoma MG-63 cells in logarithmic growth phase was treated with UA (10, 20, 40μg/mL) and Cisplatin (40μg/mL).The cellular growth inhibition rate was calculated by MTT, cell cycle and apoptosis rate were analyzed by flow cytometry, the expression of Bax mRNA and bcl-2 mRNA were detected by RT-PCR, the expression of caspase-3 protein was detected by western blotting.Results The cellular growth inhibition rate of human osteosarcoma MG-63 cell in UA treated groups were significantly increased;the G0/G1 phase of the cell cycle was prolonged and the G2/M phase was shortened, the apoptosis rate was significantly increased;the expression of Bax mRNA was significantly increased, while the expression of bcl-2 mRNA was significantly decreased, and the ratio of Bax/bcl-2 was significantly increased;the expression of caspase-3 protein was significantly increased;all of the effects above were dose-dependent with a certain.Conclusions UA can effectively inhibit human osteosarcoma MG-63 proliferation and promote it apoptosis, which perhaps related to its effects of arresting cell cycle and regulating the expression of apoptosis-related genes and proteins.